Background:  Studies have shown a decline in AIDS-defining malignancies since the advent of highly active antiretroviral therapy (HAART).  However, the incidence of non-AIDS defining cancers among HIV-infected individuals seem to be increasing. We determined the incidence of 5 cancers among HIV Outpatient Study (HOPS) patients relative to that observed in the general population.

Methods:  Age-, race-, smoking-, and gender-adjusted relative rates of 3 AIDS-defining malignancies (Kaposi’s sarcoma [KS], non-Hodgkin’s lymphoma [NHL], and cervical cancer) and 5 non-AIDS defining malignancies (lung, head/neck, Hodgkins disease [HD], anorectal, melanoma) in 7893 patients at 2 Chicago HIV clinics were compared with 20 million Cook County and 92 million Illinois cancer registry patients; and 4053 HOPS (excluding Chicago sites) patients were compared with 334 million SEER registry patients, representative of the general population, for the years 1992 to 2002. 

Results:  KS and cervical cancer, but not NHL, incidence has declined in the HAART era (1996-2002), but incidence of 5 non-AIDS malignancies was much higher in the HOPS population relative to the general population.  Among the HOPS patients, in analyses adjusted for age, race, smoking, and gender, incidence of these 4 cancers was significantly greater than expected from SEER data:  lung (RR_adj = 2.13 [95% CI:  1.06, 4.27]), HD (RR_adj = 4.58 [95%CI:  3.10, 6.77]), anorectal (RR_adj = 10.13 [95% CI:  7.48, 13.72]), melanoma (RR_adj = 2.99 [95% CI:  1.71, 5.22]). Among Chicago clinic patients all 5 were significantly increased in the multivariate analysis:  lung (RR_adj = 3.63 [95% CI:  2.18, 6.05]), HD (RR_adj = 77.43 [95% CI:  19.37 - 309.55]), anorectal (RR_adj = 5.03 [95% CI:  4.76, 5.33]), melanoma (RR_adj = 4.10 [95% CI: 9.39 - 152.70]), head/neck (RR_adj = 9.96 [95% CI: 2.49 - 39.79]). However, the incidence of other common cancers‑such as breast, colon, and prostate‑were not significantly increased in either population examined.

Conclusions:  Relative to the general population, the incidence of 5 non-AIDS defining malignancies has notably increased in HIV-infected individuals despite age, race, gender, and smoking history. 

Keywords: malignancies; HAART; HIV